The 5 Toughest Challenges for New RTs - And How to Crush Them

Your first shift as a new RT is a whole different world from clinicals.

No more preceptor watching over your shoulder. No more safety net. Now, it’s you and your decisions that impact patient care. And that’s when the real learning begins.

Every RT remembers the first time they had to make a critical decision on their own. The moment they realized they had to trust their knowledge, their training, and their instincts.

But stepping into this role can feel overwhelming. The good news? Every great RT has been where you are. Here are some of the biggest challenges new RTs face—and how to crush them.

Overcoming "Imposter Syndrome"

Many new RTs feel like they don’t belong or worry they’ll make mistakes. You’re surrounded by seasoned therapists, nurses, and doctors, and suddenly, you feel like the least experienced person in the room.

And then—it happens. You make a mistake. Your brain locks up. Instead of recovering, you fall into the paralysis of analysis. You start overthinking every decision, doubting yourself at every turn. Next thing you know, you’re falling behind, and the whole medical team starts questioning whether you’ll survive in this field.

?? How to Overcome It:

? Remember: EVERY RT started where you are now. Even the best therapists had a first day.

? Ask questions. No one expects you to know everything—what they expect is that you’re willing to learn.

? Confidence comes with experience. Keep showing up, keep learning, and one day, you’ll be the one mentoring new RTs.

? Bounce back from mistakes quickly. Own it, correct it, and move on—your response to mistakes defines you more than the mistake itself.

Mastering Ventilator Management Under Pressure

Ventilators can be intimidating when you’re new. And nothing is more terrifying than a vent alarm blaring while everyone in the room turns to you for answers.

?? How to Overcome It:

? Get hands-on practice. The more time you spend adjusting vent settings in a safe environment, the more confident you’ll be.

? Use a mental checklist. If an alarm goes off, go through a step-by-step troubleshooting process instead of panicking.

? Start with the patient first, then work your way to the machine. Check chest rise, listen for breath sounds, and assess oxygenation before assuming it’s a vent issue. The problem isn’t always the machine!

? Stay calm! If you panic, everyone else will too. Take a breath, focus, and trust your training.

Handling Your First Code Blue

Your heart is pounding, your hands are shaking, and your brain feels like it just emptied itself. The first time you’re in a code blue, it feels like everything is happening at lightning speed.

?? How to Overcome It:

? Know your role. If you’re on compressions, do compressions. If you’re managing the airway, focus on that. Stay in your lane.

? Follow the lead of experienced RTs and nurses. They’ve been through this before—watch, learn, and anticipate what’s coming next.

? Anticipate the needs of the code. Is the crash cart still at the nurse’s station? Grab it. Is someone putting the patient on the monitor? Get vital signs. The faster you can predict what’s needed, the more valuable you become to the team.

? The more codes you’re in, the more natural it will feel. One day, you’ll look back and realize you’ve become the calm one in the room.

Time Management on a Hectic Shift

Balancing vent checks, breathing treatments, ABGs, patient assessments, and charting—it’s easy to feel like you’re drowning in work. And then, just when you think you're caught up, a stat ABG gets ordered.

?? How to Overcome It:

? Prioritize based on patient acuity. Not every treatment needs to be done exactly on time. Some patients need you more than others.

? Develop a workflow that makes sense. Group tasks by location so you’re not running back and forth all shift.

? Ask for help when you need it. A strong RT team has each other’s backs—use that teamwork to your advantage.

? If you get confused, write it down. Keeping track of your patient information allows you to continually adjust your medication schedule, track treatments, and stay organized. And if a doctor happens to walk in and ask you a question, you have your information at hand—no scrambling, no guessing.

Earning the Respect of Nurses and Doctors

As a new RT, some staff may underestimate your abilities. You might get asked, “Are you new?” with that look of doubt, or a nurse might second-guess your vent change suggestion.

?? How to Overcome It:

? Show confidence in your skills. If you act unsure, people will treat you like you’re unsure.

? Prove your knowledge. Be prepared when you make recommendations—have your reasoning backed by solid RT practice.

? Respect goes both ways. Work well with the team, communicate clearly, and you’ll earn their trust over time.

? Round frequently. The more you check on your patients and interact with them, the more staff will see you and notice how you communicate. If you can make a patient laugh, you’ll make the staff laugh too—giving them insight into your personality and making you more approachable.

Final Thoughts: You’ve Got This!

Every great RT started out as a nervous new grad. The key is to keep learning, keep asking questions, and never be afraid to step up when your patients need you.

?? What was the biggest challenge YOU faced as a new RT? Let’s share our experiences and help the next generation!

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